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NPI Code Detail

MEDICARE: ROGER J BEAL DPM

MEDICARE: ROGER J BEAL DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1790955938
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROGER J BEAL DPM
Provider Business Mailing Address
First Line : 4499 MEDICAL DR
Second Line : #343
City : SAN ANTONIO
State : TX
Zip : 78229-3713
Country : US
Telephone Number : 210-614-3623
Fax Number : 210-614-2329
Provider Business Practice Location Address
First Line : 4499 MEDICAL DR
Second Line : #343
City : SAN ANTONIO
State : TX
Zip : 78229-3713
Country : US
Telephone Number : 210-614-3623
Fax Number : 210-614-2329
Authorized Official
Title or Position : OWNER
Name : ROGER J BEAL
Credential : DPM
Telephone Number : 210-614-3623
Provider Enumeration Date : 03/04/2008
Last Update Date : 03/04/2008

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Directions to “ROGER J BEAL DPM ” Practice Location

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